Doctors' strategies in prescribing drugs: the case of mood-modifying medicines

Abstract

Background. Little is known about doctors' decision-making processes in prescribing antidepressants and how this is handled. Objective. To describe and understand doctors' strategies in prescribing mood-modifying drugs, especially when confronted with challenging patients or situations. Methods. Face-to-face interviews were conducted with GPs in Gottingen and Hannover, two areas in the north of Germany. GPs were enrolled until a sufficient variation ('saturation') had been reached (n = 19). Interviews were audiotaped and then transcribed verbatim. To analyse the GPs' concepts and strategies in prescribing antidepressants, the interviews were structured according to themes and recurrent items extracted by theoretical coding. Results. We identified four main strategies used by GPs in the pharmacological management of depressive patients: marketing additional beneficial drug effects, addressing the patients as experts, somatic attribution of the disease and referral to a specialist. Conclusions. To support their prescription, GPs use a variety of strategies to motivate both patients to take a certain drug and themselves to deal with difficult patients or situations in their management of depression.